腰椎间小关节螺旋CT三维测量、观察及临床意义

目的:观察腰椎间小关节关节面的三维解剖学形态,并探讨其临床意义.方法:60例螺旋CT扫描腰部阴性正常人,行三维重建后处理.在横轴面、冠状面及矢状面观察关节面形态.结果:关节突关节面的标准形态,横轴面,腰1/2节段上、下关节突关节面为曲度相同的"C"形;腰2/3、3/4、4/5节段上、下关节突关节面为曲度不相同的"C"形,下关节突关节面曲度较小,上关节突关节面曲度较大;腰5/骶1节段男性下关节突关节面"l"形,上关节突关节面"C"形,女性上、下关节突关节面均为"l"形.冠状面,腰1/2、2/3节段为椭圆形.腰3/4节段男性为椭圆形;女性为长方形.腰4/5节段男性为椭圆形;女性为椭圆形或长方形.腰5/骶1节段男女均可为圆形;或男性为方形女性为长方形.矢状面,为"l"形.结论:腰椎间小关节关节面形态在诸节段及横轴面、冠状面及男、女间不尽相同.     

腰椎小关节不对称与椎间盘及小关节退变的关系

背景：腰椎小关节不对称与椎间盘退变程度之间的关系一直存在争议,并且国内在下腰痛患者中对小关节不对称与小关节退变程度之间关系的研究较少。 目的：调查分析腰椎小关节不对称在腰椎间盘退变与小关节退变过程中的作用。 方法：测量312例下腰痛患者共936个脊柱功能单位的小关节角度差值,差值<7°定义为小关节对称,差值≥7°定义为小关节不对称。对936个脊柱节段的椎间盘退变程度及小关节退变程度进行分级。 结果与结论：①小关节是否对称在年龄及性别上差异无显著性(P > 0.05)。②小关节不对称与椎间盘退变程度之间无显著关联(P > 0.05)。③在L4~L5节段小关节不对称组比小关节对称组的小关节退变程度更重(P < 0.01)。提示小关节不对称与椎间盘退变无明显影响,但在腰椎活动度最大的L4~L5节段,小关节不对称可能会引起小关节的退变。     

椎间盘髓核摘除对腰椎间小关节承载功能影响的实验研究

目的分析椎间盘髓核摘除后腰椎小关节受力大小及变化情况。方法采用8具新鲜脊柱腰骶段(L1~S1)标本,在MTS系统上用压敏片分别测量L3-L4、L4-L5两个节段小关节面在中立位和前屈、后伸位时受力大小;摘除L4-L5椎间盘髓核,重复测量。结果完整脊柱标本中,L4-L5与L3-L4节段关节面受力大小相似:中立位时受力占轴向压缩载荷的15%;前屈10°、20°时受力占压缩载荷的比例减为9%、5%;后伸10°、20°时受力占压缩载荷的比例增至23%、33%。L4-L5椎间盘髓核摘除后,L4-L5节段小关节面在各个运动状态下受力均显著增大,而L3-L4节段小关节受力也有增加的趋势。结论腰椎小关节有一定的承载功能。腰椎间盘切除术后,同一平面及相邻平面小关节受力增加,可能引发腰痛。     

颈椎间关节关节面的形态、面积及其力学分析

在45套(男25,女20)通辽地区出土的干燥成人骨骼标本上,观测了颈椎间关节关节面的形态和面积。颈椎间关节关节面的形态可分为圆型、椭圆型和不规则型,各节段均以椭圆型占优势。各节段下关节突关节面的面积均大于上关节突关节面的面积,但仅颈4～5和颈5～6节段有显著性差异。     

小关节角矢状化、椎间盘退变对退变性腰椎滑移作用的有限元研究

目的探讨小关节矢状化与椎间盘退变间的关系及其对退变性腰椎滑移的作用和意义。方法采用一种新型CAD方法精确构建65°小关节角、45°小关节角、25°小关节角与正常椎间盘、轻度退变椎间盘、重度退变椎间盘相组配的9种腰椎L4-L5活动节段有限元模型。生理压缩载荷下,分别对9种有限元模型的生物力学参数进行测试。结果与小关节角45°和25°有限元模型相比,小关节角65°有限元模型的矢状方向椎体前移位增加,关节突、峡部等效应力和关节突水平方向接触力明显增加;小关节角65°有限元模型的终板膨出减小,纤维环基质应力增加。与正常有限元模型相比,椎间盘轻度退变有限元模型刚度下降,小关节突及峡部应力轻度增加。9种有限元模型中,轻度退变椎间盘结合小关节角65°有限元模型的抗前剪力能力最差。结论小关节角矢状化既是退变性腰椎滑移的原发诱因,又是局部应力变化导致关节突再塑形的继发病理改变,矢状型小关节腰椎活动节段矢状方向内在不稳定性受椎间盘退变程度的影响,椎间盘退变对小关节角矢状化无明显促进作用。     

腰椎小关节不对称与小关节退变程度的关系及其临床意义

目的探讨退行性腰椎滑脱(Degenerative Lumbar Spondylolisthesis,DLS)腰椎小关节不对称与小关节退变程度的关系及其临床意义。方法随机从2004年5月～2009年8月我院收治的102例DLS患者中选取60例作为观察组,从300名在我院行体检无脊柱疾患的人员中选取与DLS组年龄、性别相匹配的60名作为对照组。在MRI上测量L3/4、L4/5、L5/S1两侧小关节角并计算出小关节不对称角度,同时观察小关节的退变程度,将其分为4度。并对所测参数进行相关性分析。结果腰椎左侧小关节方向比右侧更偏向矢状位,但这仅在DLS组L3/4(P=0.003)、L4/5(P=0.000)两个节段有统计学意义。两组L4/5小关节不对称与L3/4、L5/S1相比更严重,DLS组小关节不对称角度与对照组相应节段相比更大,小关节的退变程度更加严重,小关节不对称随着小关节退变程度的增加而增加。结论 (1)小关节不对称在下腰椎中普遍存在;(2)小关节不对称与小关节的退变程度呈正相关;(3)小关节不对称不仅是小关节骨性关节炎重塑的结果,而且是小关节先天存在的形态学异常;(4)小关节不对称增加了DLS的危险性,小关节不对称及退变程度对DLS具有病因学意义。     

腰椎小关节穿刺的应用解剖

目的:研究腰椎小关节穿刺的解剖入路,供临床参考应用。方法:采用新鲜成人脊柱腰段标本35(男22、女13)例,通过横断断层解剖学方法,从横断面上对L1～2～L5～S1腰椎小关节的类型、关节角、上下关节突间距以及关节面的形态等进行观测。结果:①关节类型L1～2～L5～S1主要为上凹面型(82.6%)和平面型(17.4%),其中L5～S1有51.4%为上凹面型,48.6%为平面型;②关节角从L1～2至L5～S1腰椎关节突关节角逐渐增大,分别为26°、30°、35°、40°、45(°女性平均略大3°～5°);③关节的位置在后正中线外侧,相应的上、下腰椎棘突后缘中点之间,与后正中线的距离由上到下逐渐增加,分别为14.20、15.74、18.90、24.22、27.20mm;④穿刺要经过皮肤、浅筋膜、胸腰筋膜后层、竖脊肌、关节囊后壁。结论:腰椎小关节穿刺应根据关节的类型、关节角大小选择相应腰椎间隙中点的外14.20～27.20mm(平均20.05mm)处进行。     

腰椎小关节退变的相关因素及生物力学特点

文题释义：腰椎小关节：为相近节段腰椎上位椎体的下关节突与下位椎体的上关节突组成的腰椎后外侧关节,将一个腰椎的椎弓与相邻腰椎的椎弓相连,在腰椎运动中占据着重要的地位。 生物力学：是应用力学原理和方法对生物体中的力学问题定量研究的生物物理学分支,研究范围从生物整体到系统组织,其研究重点是与生理学、医学有关的力学问题。 背景：腰椎小关节退变近年来成为学者们研究的重点,认识腰椎小关节退变的危险因素对于预防以及减少脊柱损害具有关键性作用,并且了解其解剖结构对于治疗脊柱相关疾病及手术实施有着重要的指导意义。 目的：简述腰椎小关节解剖学、组织学特性,总结能够引起腰椎小关节退变的相关危险因素。 方法：利用计算机检索CNKI、万方、维普、PubMed、Elsevier和Web of Science数据库2018年3月至2019年9月有关腰椎小关节退变的文章,检索词为“腰椎小关节,关节囊,关节面方向,神经支配,骨性关节炎,生物力学,下腰痛,椎间盘退变,腰椎滑脱,腰椎退行性脊柱侧弯,lumbar facet joint,joint capsule,articular direction,eneurosis,osteoarthritis,biomechanics,low back pain,intervertebral disc degeneration,umbar spondylolisthesis,lumbar degenerative scoliosis”。查阅相关文章,包括综述、基础研究及临床研究,通过阅读标题及摘要进行初步筛选,排除与主题相关度低的文献,最终共纳入60篇文献进行结果分析。 结果与结论：①腰椎小关节退变的主要危险因素包括年龄、性别、异常应力、关节面方向、关节不对称性、腰椎节段和椎间盘退变;②关节退变后会导致下腰痛、椎间盘退变、腰椎滑脱、退行性脊柱侧弯等临床疾病的发生和发展,严重影响患者的日常生活和工作,降低生活质量。因此,腰椎小关节在脊柱相关疾病的治疗中不应该被忽视。 ORCID: 0000-0002-5700-8674(文王强) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

腰椎经皮内镜下不同部位关节突成形对相关节段活动度的影响

目的利用三维有限元法评估腰椎经皮内镜下不同的关节突成形部位对椎体活动度(range of motion, ROM)的影响。方法建立正常L3～5三维有限元模型,模拟腰椎经皮内镜技术分别在L5上关节突"尖部"或"基底部"做直径0.75 cm圆柱状骨切除以模拟椎间孔成形,从而获得正常L3～5模型、关节突尖部成形模型和关节突基底部成形模型。给予特定加载条件,比较3种模型在前屈、后伸、左右侧曲、左右旋转工况下L3～4、L4～5节段ROM变化情况。结果 L5上关节突尖部成形后,在后伸、左右侧屈、左右旋转状态下L4～5节段ROM均较正常明显增大,以左旋最为明显;L5上关节突基底部成形后,在左右旋转状态下L4～5节段ROM较正常稍微增大。L5上关节突尖部、基底部成形后在6种不同运动状态下临近节段L3/4的ROM均无明显变化。结论腰椎经皮内镜技术下,L5上关节突尖部成形较关节突基底部成形对L4～5节段ROM影响较大。L5上关节突成型对临近节段L3～4的ROM无明显影响。     

腰椎小关节的生物力学

腰椎小关节是腰椎运动节段的重要组成部分，能控制腰椎运动节段的活动，承载施加于腰椎上的负荷，与椎间盘，韧带，包括关节囊一起维持腰椎的稳定性。同体内其他关节一样，当腰椎小关节承受异常的活动或应力时，易发生退行性变或发生小关节骨关节炎。Goldthnait于1911年首次提出腰椎小关节退变可引起腰背痛的假设。Ghormley于1933年提出了小关节综合征这一概念，并延用至今。现在，越来越多的研究表明腰椎小关节的迫性性变是引起腰椎不稳定和下腰痛的重要原因[1,2,3]，有学者估计15％到40％的慢性下腰痛同小关节有关[4]，因此腰椎小关节的…     

A herbal medicine used in the treatment of addiction mimics the action of amphetamine on in vitro rat striatal dopamine release

Human low back pain sometimes originates from lumbar facet joints. In human lumbar facet joint inflammation or degeneration, the referred pain is not only expanded into the low back area but also into the leg or foot. The rat L5-L6 facet joint is innervated by the L1-L5 dorsal root ganglia. The presence of brain-derived neurotrophic factor-immunoreactive dorsal root ganglion neurons innervating the L5-L6 facet joint has been confirmed, but changes in the number and distribution of these neurons caused by inflammation have not been studied. Of fluorogold-labeled neurons innervating the L5-L6 facet joint, the proportion of brain-derived neurotrophic factor-immunoreactive dorsal root ganglion neurons was 16% in the control group and 26% in the inflammatory group. The proportion of brain-derived neurotrophic factor-immunoreactive dorsal root ganglion neurons labeled by fluorogold was significantly higher in the inflammatory group than in the control group (P<0.05). The mean cross-sectional area of fluorogold-labeled brain-derived neurotrophic factor-immunoreactive cells increased from 580 to 915 microm(2) in the inflammatory group (P<0.01). Associated with inflammation in facet joints, the increase of brain-derived neurotrophic factor-immunoreactive neurons and the phenotypic switch to large neurons may induce the expansion of facet joint inflammatory pain.     

椎间盘不对称切除对小关节压力及腰椎稳定性的影响

目的探讨腰椎间盘不对称切除对小关节压力及腰椎稳定性的影响。方法采用7具人体脊柱标本(L2~3),制备完整椎间盘组、1/4椎间盘切除组、1/2椎间盘切除组,对标本施加7.5 N·m的屈伸、侧弯和轴向旋转方向的纯力偶矩,记录腰椎运动范围(range of motion,ROM)和小关节压力。结果后伸方向,1/4椎间盘切除状态下非切除侧小关节压力显著性增大;侧弯方向,1/2椎间盘切除状态下的两侧小关节压力均有显著性增大;轴向旋转方向,1/2椎间盘切除状态下仅切除侧小关节压力显著性增大。1/4椎间盘切除、1/2椎间盘切除状态下的ROM均大于完整椎间盘,但前屈方向各组间ROM无差别,各组间侧弯和轴向旋转的ROM在左、右侧无差别。结论腰椎间盘不对称切除导致腰椎除前屈方向外稳定性下降和小关节压力不对称性增大,提示腰椎间盘不对称退变引起腰椎不稳和小关节压力增大可产生腰痛。     

Morphometrical study of the joint surface and capsule of the lumbar zygapophysial joint with special reference to their laterality

Using 26 osteoligamentous lumbar vertebral columns (260 facets), we morphometrically investigated the cartilagenous joint surface, inner capsular surface and capsular thickness. We also examined whether the subcapsular pocket was present and, if present, how far it extended along the joint margin. The proportion of the inner capsular area in the total joint surface area in a facet (the capsular-joint surface ratio) was hypothesized to correspond to the potential looseness (or tightness) of the facet. The absolute data themselves seemed to be useful for better understanding of the joint morphology. However, further evaluations of the differences between segments, left/right differences, individual segmental fluctuation patterns and correlations between parameters provided a novel classification of specimens according to the hypothetical progress of joint degeneration. Criteria for the classification existed in 1) the laterality in parameters defined as more than 100% larger or smaller than the contralateral facet and 2) the drastic segmental difference in parameters over 50% larger or smaller than the adjacent segment. Consequently, three types were identified: 1) outside of the criteria in both area and thickness (-/- type, 9 of 26); 2) the criteria did not fit the area parameters but did fit the thickness parameters (-/+ type, 8); the criteria were filled in both categories of parameters (+/+ type, 9). Notably, in the +/+ types, the capsular thickness and capsular-joint surface ratio correlated significantly (p < 0.01), i.e., the hypothetical loose joint had a thick capsule. We speculated that early joint degeneration starts from the -/- type and advances via the -/+ type to the +/+ type. Considerating these results, we recommended using MR imaging for detailed identification of laterality in the capsular thickness for low-back pain patients to discriminate candidates for future severe degenerative changes of the articular cartilage in the lumbar spine.     

Different staining methods used for human lumbar facet joint cartilage: A comparative study北大核心

BACKGROUND: With the development of modern pathological techniques, the misdiagnosis rate has been reduced remarkably, but special stains are still the most important method for pathological diagnosis. OBJECTIVE: To compare the advantages and disadvantages of different special stains used for observing the structure of human lumbar facet joints. METHODS: The specimens of facet joint cartilage at L4/5 level were collected from patients undergoing lumbar surgery, and then stained with hematoxylin-eosin, safranin O, toluidine blue, Masson, and saranin-O-fast green for structure observation. RESULTS AND CONCLUSION: The structure of the articular cartilage could be observed clearly through hematoxylin-eosin, toluidine blue, and saranin-O-fast green staining. The cartilage surface, tidemark, and subchondral bone were shown by the hematoxylin-eosin staining, with the presence of violet chondrocyte nuclei. Safranin-O-fast green staining showed the four layers of the cartilage clearly, including the shallow layer (cartilage surface), middle layer (spherical cells arranged in disorder), columnar cell layer (large and multinucleated chondrocytes arranged neatly), tidemark, subchondral bone layer; and the cartilage matrix was reddish uniformly, the subchondral bone was green, and the cartilage and bone tissue showed a striking contrast. The cartilage structure was unclear in toluidine blue staining, with clear nuclei and almost no coloring cytoplasm, but the matrix appeared with slight purplish blue. Safranin O staining showed that the cartilage was red, which had no obvious boundary with the cartilage matrix, and chondrocytes were stained lightly. Masson staining showed clear collagen fibers, but the structures of the cartilage and subchondral were obscure. To conclude, safranin-O-fast green staining can achieve the best results, followed by hematoxylin-eosin staining and Masson staining in turn. © 2017, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.     

Development of a versatile intra-articular pressure sensing array

A new sensor array intended to accurately and directly measure spatial and time-dependent pressures within a highly curved biological intra-articular joint was developed and tested.To evaluate performance of the new sensor array for application within intra-articular joints generally, and specifically to fit within the relatively restrictive space of the lumbar spine facet joint, geometric constraints of length, width, thickness and sensor spatial resolution were evaluated. Additionally, the effects of sensor array curvature, frequency response, linearity, drift, hysteresis, repeatability, and total system cost were assessed.The new sensor array was approximately 0.6 mm in thickness, scalable to below the nominal 12 mm wide by 15 high lumbar spine facet joint size, offered no inherent limitations on the number or spacing of the sensors with less than 1.7% cross talk with sensor immediately adjacent to one another. No difference was observed in sensor performance down to a radius of curvature of 7 mm and a 0.66 ± 0.97% change in sensor sensitivity was observed at a radius of 5.5 mm. The sensor array had less than 0.07 dB signal loss up to 5.5 Hz, linearity was 0.58 ± 0.13% full scale (FS), drift was less than 0.2% FS at 250 s and less than 0.6% FS at 700 s, hysteresis was 0.78 ± 0.18%. Repeatability was excellent with a coefficient of variation less than 2% at pressures between 0 and 1.000 MPa. Total system cost was relatively small as standard commercially available data acquisition systems could be utilized, with no specialized software, and individual sensors within an array can be replaced as needed.The new sensor array had small and scalable geometry and very acceptable intrinsic performance including minimal to no alteration in performance at physiologically relevant ranges of joint curvature.     

Physiological incongruity of the humero-ulnar joint: a functional principle of optimized stress distribution acting upon articulating surfaces?

Investigations into the distribution of subchondral bone density in the human elbow have suggested that the geometry of the trochlear notch deviates from a perfect fit with the trochlea, and that the load is transmitted ventrally and dorsally rather than through the centre of the humero-ulnar joint. We therefore decided to make a quantitative assessment of the degree of incongruity between the two components in 15 human specimens (age distribution 60 to 93 years) with different types of joint surface. Polyether casts of the joint cavity were prepared under loads of 10,40,160 and 640 N. The thickness of the casts was then measured at 50 predetermined points, and an area distribution of the width of the joint space represented in a two-dimensional template of the trochlear notch. The reproducibility of this procedure was tested by image analysis. At a load of 10 N, only a narrow space was present ventrally and dorsally in the joint, but in the depths of the trochlear notch a width of 0.5 to 1 mm was recorded in the centre, and up to 3 mm at its medial and lateral edges. Specimens with continuous articular cartilage showed a lower degree of incongruity than those with a divided articular surface. As the load was increased to 640 N, however, the original incongruity between the articular surfaces disappeared almost completely. The joint surfaces became more congruous, probably because of the viscoelastic properties of the articular cartilage and the subchondral bone, and the contact areas merged in the centre of the joint. It is suggested that this physiological incongruity brings about an optimal distribution of stress over the articular surface during the transmission of the load, and it may lead to better nourishment of the articular cartilage by providing intermittent mechanical stimulation and circulation of the synovial fluid.     

Association of rudimentary sacral zygapophyseal facets and accessory and ligamentous articulations: Implications for load transmission at the L5‐S1 junction

Weight transmitted from the fifth lumbar vertebrae to the sacrum is distributed as three separate components between (a) the vertebral bodies anteriorly, (b) the transverse elements intermediately, and (c) the lumbosacral facet joints, posteriorly. The posterior components of the fifth lumbar vertebra share greater proportion of load in comparison with the posterior elements of the upper lumbar vertebral levels. This study focuses on rudimentary lumbosacral facet articulations and their possible effects on load sharing at this region. Twenty sacra bearing rudimentary articulations were collected for analysis. Sixteen of these sacra presented unilateral rudimentary facets, and the remaining four had facets that were bilaterally rudimentary. Thirteen of the sacra with unilateral rudimentary facets showed an accessory articulating area on the upper surface of the ala on the same side as the rudimentary zygapophyseal facet. The remaining three sacra (out of the 16) showed evidence of strong ligamentous attachments between the L5 and S1 transverse elements on the sides of the rudimentary facets. All the sacra with bilateral rudimentary facets demonstrated bilateral accessory L5–S1 articulations. These observations indicated that load transmission at lumbosacral junctions bearing a rudimentary facet joint is not normal and that their associations with strong L5–S1 lumbosacral ligamentous attachments or accessory articulations at the transverse elements serve a compensatory mechanism for load sharing. Clin. Anat. 23:707–711, 2010. © 2010 Wiley‐Liss, Inc.     

有限元分析不同牵伸时长相邻腰椎节段和椎间盘应力及位移的变化

文题释义：脊柱手法床：该手法床是模拟南少林骨伤科整脊手法,将传统医学通督脉理论与现代牵伸理论相结合的一种机械设备。具体操作是借助智能调控高压缓冲气室对气柱速率和频率的调节及气阀门控制系统对气体的充放,可以模拟㨰动、弹拨、牵伸等多种手法,有利于促进手法的规范化、自动化发展。 腰椎三维有限元分析：腰椎三维有限元模型的建立是通过CT、MRI 等途径获取腰椎的影像学资料,使用MIMICS、GEOMAGIC STUDIO 以及HYPERMESH等相关的软件对图像进行处理并建立三维有限元模型。随着科学技术的不断发展,腰椎有限元模型的建立在一定程度上完善了腰椎间盘、椎体间小关节、连接韧带、关节囊等软组织以及周围肌肉等结构的模型建立。 背景：与传统牵伸手法对比,利用脊柱手法床气柱叠加结构进行牵伸可以很好地掌控牵引时间,通过有限元分析能详细计算出相邻腰椎节段的应力,为临床脊柱手法床的腰椎牵引提供更好的牵引处方理论依据。 目的：利用脊柱手法床模拟倒盖金被手法进行牵伸,并通过有限元分析不同牵伸时长对相邻腰椎节段应力大小及分布的影响。 方法：选择健康男性志愿者1例,年龄26岁、身高174 cm、体质量60 kg,受试者对试验方案理解并签署知情同意书,研究获得福建中医药大学附属康复医院伦理委员会的批准(批准号：2016XJS-001-01)。依据志愿者T₁₂-S₁的CT图像,建立正常人体腰椎的有效三维有限元模型,通过三维有限元分析利用脊柱手法床顶推L₃棘突时,L₃在手法的牵引下分别维持至10,20,30 s时,上下相邻的腰椎间盘、椎小关节的应力变化情况,并且分析该变化的内在规律及作用机制。 结果与结论：①顶推高度为5 cm,作用时长介于1.25-17 s时,相邻腰椎节段的应力值是持续增大的,椎间盘：L₂-L₃为4.60-5.68 MPa,L₃-L₄为5.26-6.61 MPa;椎小关节：L₂-L₃为7.01-8.67 MPa,L₃-L₄为5.22-6.50 MPa;②在顶推作用时长超过24 s以后,相邻椎间盘、椎小关节应力基本保持不变;③因此脊柱手法床作用于腰椎时对相邻腰椎节段不会造成损伤;使用脊柱手法床的作用时长应在25-30 s之间。 ORCID: 0000-0002-4468-1464(李民) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

腰椎融合术中椎弓根螺钉损伤关节突关节的研究进展

目的 探讨腰椎融合术中椎弓根螺钉损伤关节突关节的生物力学、发生率及相关影响因素的研究进展。方法 在PubMed、Springerlink、Medline、CNKI、万方数据等数据库中,以“腰椎融合术、椎弓根螺钉、关节突关节损伤”和“lumbar interbody fusion、pedicle screw、facet joint violation”为关键词,检索2003年1月—2015年12月有关腰椎融合术中椎弓根螺钉损伤关节突关节的相关研究成果,针对椎弓根螺钉损伤关节突关节的生物力学、发生率及相关影响因素的研究进行分析总结。结果 关节突关节是维持脊柱运动节段稳定的重要结构,其损伤可导致关节突关节挛缩、僵硬及骨性关节炎,从而加速邻近节段退变的发生。手术创伤是造成关节突关节损伤的重要因素,尤其是以术中植入椎弓根螺钉内置物损伤关节突关节为主。无论是开放置钉还是微创置钉,螺钉损伤关节突关节的发生率均较高。影响椎弓根螺钉损伤关节突关节的因素包括年龄、性别、体质量、融合节段、融合数量、手术方式、术中CT导航、置钉方位、置钉方法和螺钉类型等。结论 关节突关节损伤继而增生退变是导致邻近节段退变的重要危险因素,无论是开放还是微创置入椎弓根螺钉均可增加关节突关节损伤的发生,因此外科医师在置钉时需要注重关节突关节的保护,规避不良置钉影响因素。